Sunday, May 1, 2005

Progesterone can
curb preterm births

A researcher says the hormone
helps women who have had
premature babies

Use of progesterone shots early in a pregnancy can reduce the risk of preterm births in women who previously had premature babies, says an internationally noted obstetrician/gynecologist, and researcher.

Women who've had a preterm birth have a 25 percent risk of another premature baby, and that is cut in half by weekly progesterone injections, said Dr. Thomas J. Garite, who recently stepped down as University of California, Irvine, chairman of Obstetrics and Gynecology.

"This is one of the few big things to come along in a long time from the perspective of making a difference," he said in an interview here yesterday.

Progesterone is a naturally occurring hormone that prevents the uterus from going into labor, but it won't work for every patient, he said.

Garite was keynote speaker at the second annual Hawaii Prematurity Summit sponsored by Kapiolani Medical Center for Women and Children, March of Dimes Hawaii Chapter and Straub Foundation.

One in seven Hawaii babies, or 13.7 percent, was born premature in 2002. That compares with the national average of 12.1 percent for that year, according to the National Center of Health Statistics.

The 13.7 percent rate represented a 33 percent increase since 1992 compared with a national increase of 13 percent during the same period.

A national Prematurity Awareness Campaign to raise public awareness of the problems has been extended by the March of Dimes from 2007 to 2010 to meet Healthy People 2010 objectives.

The goal is to reduce the premature birth rate nationally to 7.6 percent in 2010.

Speaking largely to health professionals at Kapiolani Medical Center, Garite, editor-in-chief of the American Journal of Obstetrics and Gynecology, said he's has been frustrated throughout his career by a lack of focus on premature births and the adverse outcome to the baby.

He said he believes it's more of a public health and environmental matter than a medical one, noting a high correlation of premature births to poverty, under-education, teen pregnancies, stress and other factors.

For example, he said second- and third-generation Mexican Americans in California are starting to have premature births, which aren't due to genetics. "It may be more about lifestyle or becoming Californiaized.

"A lot of this is social disease and not a medical disease."

But at some point it becomes a medical problem, said Dr. Kenneth Ward, University of Hawaii John A. Burns Medical School chairman of Obstetrics/Gynecology.

Lifestyle issues, such as smoking, drinking alcohol, along with stress, affect the chemistry of a pregnancy and the baby, he pointed out.

Ward said his group will look at all aspects of premature births under a $13 million federal grant when the new medical school research center at Kakaako opens in September.

The scientists "are focused on doing something on the prematurity problem and complications," he said.

They're investigating possible genetic associations, markers to identify women likely to give birth early, the effects of periodontal diseases with infections that travel in the bloodstream and other areas.

Garite said there are about 300,000 premature births annually in the United States.

They account for 60 percent to 70 percent of infant deaths and two-thirds of cerebral palsy, as well as other lifelong disabilities.

The reason why a baby is born prematurely isn't known in nearly half of all cases.

Describing different approaches to improving the outcome of preterm newborns, Garite said it's hard to prove that prenatal care lowers the premature birth rate.

"I'll get drummed out of March of Dimes for saying that, but that's the way it is.

"Prematurity is a different disease in different populations and we have to understand contributors in each population and work on them."

Garite said he has doubts about the March of Dime's "lofty goals" to reduce premature birth rates to 7.6 percent in 2010.

"I've been doing this 25 years and haven't seen any improvement. I would like to be proven wrong."

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